{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:45:56Z","timestamp":1791834356492,"version":"4.3.4"},"reference-count":11,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Native American (NA) patients experience persistent inequities in advance care planning (ACP) and often present to tertiary centers with critical illness; culturally respectful serious-illness communication is therefore essential in emergency and intensive care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>We developed and implemented a nursing-led, multidisciplinary educational initiative at a large academic medical center serving patients from &gt;50 tribal nations. Informed by a literature review, local practice needs, and expert input from a Native American Patient Experience Ambassador, we created (1) an \u201cHonoring Your Choices\u201d (HYC) communication card with culturally sensitive prompts for serious illness conversations and (2) a quick reference guide (QRG) outlining key cultural considerations and unit-specific resources. Tools were disseminated to seven intensive care units and the emergency department through nurse leader engagement, unit rounding, and staff education, and the initiative was presented at departmental Grand Rounds\/didactics with pre\/post surveys to assess impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven pre-session and twenty-four post-session surveys were collected from clinicians and trainees. Prior to the session, &gt;80% of respondents reported being not or only slightly confident discussing end-of-life issues with NA patients\/families; post-session surveys demonstrated increased self-reported confidence in recognizing when cultural beliefs may influence care and in conducting end-of-life discussions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This initiative demonstrates how culturally congruent approaches to serious illness conversations may support more meaningful engagement with NA patients and families. Our experience suggests that developing and evaluating a brief, point-of-care communication tool like\n                      <jats:italic toggle=\"yes\">Honoring Your Choices<\/jats:italic>\n                      may be accomplished with existing interdisciplinary partnerships, offering a practical model that other institutions can readily mirror.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261496824","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:40:37Z","timestamp":1791567637000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing Culturally Sensitive Care for Critically Ill Native American Patients and Families: An Educational Initiative and Resource Guide for Nursing and Medical Teams"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6680-8921","authenticated-orcid":false,"given":"Rachel M.","family":"Wiste","sequence":"first","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie DeCora","family":"Guimaraes","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole L.","family":"Nevel","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Goddard","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caila","family":"Rinker","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Randall","sequence":"additional","affiliation":[{"name":"School of Biomedical Sciences, Mayo Clinic Alix School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callina","family":"Johnmeyer","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Ean","family":"Yeow","sequence":"additional","affiliation":[{"name":"Mayo Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"2","key":"e_1_3_4_2_2","first-page":"129","article-title":"Advance care planning: what, when, and how?","volume":"122","author":"Toledo-Franco L","year":"2025","unstructured":"Toledo-Franco L, Peters J, Kamal AF, Traber C. Advance care planning: what, when, and how? Mo Med. 2025;122(2):129-137.","journal-title":"Mo Med"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163251344428"},{"key":"e_1_3_4_4_2","volume-title":"Advance Care Planning: Advance Directives for Health Care","author":"National Institute on Aging","unstructured":"National Institute on Aging. Advance Care Planning: Advance Directives for Health Care. U.S. Department of Health and Human Services. https:\/\/www.nia.nih.gov\/health\/advance-care-planning\/advance-care-planning-advance-directives-health-care Accessed 21 July 2025."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.017"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18498"},{"key":"e_1_3_4_7_2","volume-title":"Moving Beyond Paradigm Paralysis: American Indian end-of-life Care","author":"Baldridge D","year":"2019","unstructured":"Baldridge D, Garrett M, Williams E. Moving Beyond Paradigm Paralysis: American Indian end-of-life Care. Centers for Medicare & Medicaid Services; 2019. PDF. Accessed July 21, 2025.https:\/\/www.cms.gov\/Outreach-and-Education\/American-Indian-Alaska-Native\/AIAN\/Webinar-Archive-Documents\/EOL-AI-AN-CIB-508-compliant.pdf"},{"issue":"1","key":"e_1_3_4_8_2","first-page":"6845","article-title":"Weaving pathways: talking with our elders","volume":"22","author":"Owen MJ","year":"2024","unstructured":"Owen MJ, Nalin PM, Bouverette CA, et al. Weaving pathways: talking with our elders. Rural Remote Health. 2024;22(1):6845.","journal-title":"Rural Remote Health"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2025.1469501"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231224794"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000715"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0635-3"}],"container-title":["American Journal of Hospice and Palliative Medicine\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10499091261496824","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10499091261496824","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10499091261496824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:00:13Z","timestamp":1791831613000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10499091261496824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":11,"alternative-id":["10.1177\/10499091261496824"],"URL":"https:\/\/doi.org\/10.1177\/10499091261496824","relation":{},"ISSN":["1049-9091","1938-2715"],"issn-type":[{"value":"1049-9091","type":"print"},{"value":"1938-2715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"10499091261496824"}}